Pharmacists: Deconstruct Practice & Improve Care
- Pharmacists are being urged to adopt a novel approach to pain management, using a cupcake as a metaphor for comprehensive care.
- Kral explained that the "cupcake" represents different facets of pain management.
- This approach acknowledges that pain management strategies must be tailored to each patient's unique needs.
Pharmacists are revolutionizing pain management with a “cupcake” analogy, a fresh take on chronic pain that prioritizes personalized treatment. This innovative approach, discussed at the ASHP 2025 meeting, reimagines pain relief, focusing on a layered approach that includes functional therapy, cognitive behavioral therapy, and targeted interventions. Learn how the “cupcake” model views opioids as optional “sprinkles” rather than foundational treatments. With insights from News Directory 3, discover how pharmacists are deconstructing pain and offering holistic solutions, transforming how we address pain management strategies. Discover which patient-centered combinations are proving most effective…
Pharmacists Offer Sweet Solution to Chronic Pain Management
Updated June 09, 2025
Pharmacists are being urged to adopt a novel approach to pain management, using a cupcake as a metaphor for comprehensive care. At the American Society of Health-system Pharmacists (ASHP) pharmacy Futures 2025 meeting, Dr. Lee A. Kral and Dr. Emma Murter presented this innovative model, emphasizing personalized treatment for chronic pain relief.
Kral explained that the “cupcake” represents different facets of pain management. The cake base symbolizes functional or restorative therapy, while the flavor embodies cognitive behavioral therapy. Fillings represent interventional techniques,and frosting signifies first-line analgesics. Opioids, like sprinkles, are considered optional and not a primary treatment for chronic pain.
This approach acknowledges that pain management strategies must be tailored to each patient’s unique needs. “Everybody has different pain, so we have to tailor [treatment] to that patient,” Kral said.
Despite existing tools like NSAIDs, physical therapy, and pain scales, chronic pain affects about 24% of americans, a figure that has remained largely unchanged. Kral noted that the prevalence may be increasing, especially among American Indian, Alaska Native, and rural populations who often lack access to comprehensive care.
Pharmacists need to understand different pain phenotypes, including nociceptive, neuropathic, and nociplastic pain, to guide therapy effectively. Nociplastic pain, characterized by altered nociception without clear tissue or nerve damage, can be particularly challenging to pinpoint, Kral noted.
Murter outlined that medications like nsaids, acetaminophen, and antidepressants form the “frosting” of the cupcake, essential for managing pain. NSAIDs are foundational for inflammatory pain, while acetaminophen works for non-inflammatory pain and enhances NSAID efficacy. Adjuvants like gabapentinoids and SNRIs offer synergistic effects and should be tailored by pain phenotype.
Opioids, according to Kral, have a limited role, mainly for short-term use in acute or neuropathic pain. They are not effective for chronic nociplastic pain and may worsen it. Studies show minimal improvement in function or quality of life with long-term opioid use, along with increased adverse effects.
“Sprinkles can make the world a happier place, but if you start throwing sprinkles on frosting… then you have a hot mess. and isn’t that what happened with opioids?”
Functional therapy,such as physical therapy and yoga,forms the “cake” base. Exercise has been shown to be highly effective for knee osteoarthritis, even outperforming NSAIDs and opioids. Yoga has demonstrated significant improvements for lumbar disc herniation.
Interventions like nerve blocks and epidural steroid injections serve as “fillings,” temporarily restoring function to facilitate physical therapy. however, Kral cautioned about potential risks, such as infection or nerve injury, especially when anesthesia is involved.
The presenters emphasized the importance of “deconstructing the cupcake,” recognizing chronic pain as a biopsychosocial-spiritual disorder. Patient-centered combinations of available treatments are crucial. Pharmacists should educate patients about realistic expectations, especially for long-term chronic pain.
“What we want to do is remove the expectation that 12 years of pain are going to be removed in 12 days,” Murter said.
Mindfulness practices and a focus on lifestyle can definitely help patients regain control and improve their quality of life. Kral affirmed that pharmacists can incorporate these elements into their practice.
What’s next
Pharmacists are well-positioned to apply this personalized, layered approach to pain management. By understanding each patient’s unique pain journey, they can offer more effective care and improve outcomes for those suffering from chronic pain.